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Laparoscopic-assisted surgical staging of endometrial cancer
August 1995, Vol. 2, No. 4. Supplement The Journal of the American Association of Gynecologic Laparoscopists
endometrium would be to apply an appropriate tissuetoxic effect evenly to every part of the endometrial surface to produce a safe and consistent depth of tissue necrosis. A new system delivers heated normal saline into the uterine cavity through an insulated hysteroscope. Only a small volume of fluid is kept in a closed circuit and it is circulated at low pressure. The integrity of the system is tested by first circulating cold fluid, and only when all safety requirements are met is the fluid heated. We report some encouraging preliminary observations with this new system in patients before hysterectomy.
operation. Indications, preoperative evaluation, laparoscopic technique, and potential complications and their solutions are discussed. The procedure is easier to perform and reduces the potential risk of urinary tract injury compared with laparoscopic-assisted vaginal hysterectomy. It preserves pelvic floor physiology and anatomy. In the last 20 cases we added to the original procedure vaginal amputation of the cervix without compromising pelvic floor anatomy. We believe it is a safe method of treating benign uterine pathology.
Unusual Tubal Finding During Chromopertubation in Two Infertile Women
Laparoscopic-Assisted Surgical Staging of Endometrial Cancer
V Ghafari, Y Behjatnia, H Oabirashrafi. Endoscopy and Fertility Research Center, Tehran University of Medical Sciences, Tehran, Iran.
J Garza-Leal, O Vidal, D Saldivar, J Iglesias, R Garza. University Hospital, Monterrey, Mexico.
During regular chromopertubation in two infertile women during laparoscopy, after normal spillage of methylene blue from the tubes, suddenly the right tube in both patients began to expand in the ampullary area. The diameter of this area increased 3 or 4 times and took on a bluish color, having the appearance of dye coming out of the tube and entering the surrounding tissue. One of the patients had severe pelvic endometriosis. Does increasing pressure during routine chromopertubation cause perforation of the tube?
Five women underwent laparoscopic-assisted surgical staging of endometrial adenocarcinoma. The procedure involved peritoneal washings, vaginally assisted laparoscopic hysterectomy, bilateral salpingooophorectomy, and pelvic biopsies. These biopsies included dissection of common iliac vessels, hypogastric and external iliac vessels, and obturator nerve. An average of 10 nodes were obtained (range 8-11 nodes). In all patients both the nodes and peritoneal washings were negative. The pathologic surgical staging was IbG2 in three patients, and IaG2 and IcG2 in one patient each. The women were discharged on the sixth postoperative day, without complications. At followup in 13 to 22 weeks they were well and without tumor activity. Patients with endometrial cancer often have associated obesity, diabetes, and hypertension, and minimally invasive surgery reduces their mobidity. However, full knowledge of anatomy, oncotogic gynecology, and operative laparoscopy is imperative for performing these surgeries.
The Frequency, Diagnosis, and Reproductive Performance Associated With Incomplete Uterine Septum A Golan, M Baum, M Pansky, M Shechter, I Bukovsky. Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel.
During the last 5 years we performed 590 diagnostic hysteroscopies for reproductive failure. Among these, 78 (13.2%) cases of uterine anomalies were found; of these, 64 (82%) were partial uterine septa. Comparing hysteroscopic and hysterographic findings in these women, we found that the value of hysterography in detecting this anomally is limited; 86% of incomplete septa were missed by hysterosalpingogram. In addition, an incomplete septum may have a significant impact on reproductive failure, similar to that of a complete uterine septum.
Laparoscopic Hysterectomy With a Modified CISH Procedure EF Gassibe, E Gassibe. Instituto Proas de Procreacion Astitida y Cirugia Laparoscopica, Mendoza, Argentina.
From March 1992 to February 1995 we performed 62 laparoscopic hysterectomies, 54 of which were the classic intrafascial Semm hysterectomy (CISH). We believe this is the first Argentinian experience with this
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endometrium would be to apply an appropriate tissuetoxic effect evenly to every part of the endometrial surface to produce a safe and consistent depth of tissue necrosis. A new system delivers heated normal saline into the uterine cavity through an insulated hysteroscope. Only a small volume of fluid is kept in a closed circuit and it is circulated at low pressure. The integrity of the system is tested by first circulating cold fluid, and only when all safety requirements are met is the fluid heated. We report some encouraging preliminary observations with this new system in patients before hysterectomy.
operation. Indications, preoperative evaluation, laparoscopic technique, and potential complications and their solutions are discussed. The procedure is easier to perform and reduces the potential risk of urinary tract injury compared with laparoscopic-assisted vaginal hysterectomy. It preserves pelvic floor physiology and anatomy. In the last 20 cases we added to the original procedure vaginal amputation of the cervix without compromising pelvic floor anatomy. We believe it is a safe method of treating benign uterine pathology.
Unusual Tubal Finding During Chromopertubation in Two Infertile Women
Laparoscopic-Assisted Surgical Staging of Endometrial Cancer
V Ghafari, Y Behjatnia, H Oabirashrafi. Endoscopy and Fertility Research Center, Tehran University of Medical Sciences, Tehran, Iran.
J Garza-Leal, O Vidal, D Saldivar, J Iglesias, R Garza. University Hospital, Monterrey, Mexico.
During regular chromopertubation in two infertile women during laparoscopy, after normal spillage of methylene blue from the tubes, suddenly the right tube in both patients began to expand in the ampullary area. The diameter of this area increased 3 or 4 times and took on a bluish color, having the appearance of dye coming out of the tube and entering the surrounding tissue. One of the patients had severe pelvic endometriosis. Does increasing pressure during routine chromopertubation cause perforation of the tube?
Five women underwent laparoscopic-assisted surgical staging of endometrial adenocarcinoma. The procedure involved peritoneal washings, vaginally assisted laparoscopic hysterectomy, bilateral salpingooophorectomy, and pelvic biopsies. These biopsies included dissection of common iliac vessels, hypogastric and external iliac vessels, and obturator nerve. An average of 10 nodes were obtained (range 8-11 nodes). In all patients both the nodes and peritoneal washings were negative. The pathologic surgical staging was IbG2 in three patients, and IaG2 and IcG2 in one patient each. The women were discharged on the sixth postoperative day, without complications. At followup in 13 to 22 weeks they were well and without tumor activity. Patients with endometrial cancer often have associated obesity, diabetes, and hypertension, and minimally invasive surgery reduces their mobidity. However, full knowledge of anatomy, oncotogic gynecology, and operative laparoscopy is imperative for performing these surgeries.
The Frequency, Diagnosis, and Reproductive Performance Associated With Incomplete Uterine Septum A Golan, M Baum, M Pansky, M Shechter, I Bukovsky. Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel.
During the last 5 years we performed 590 diagnostic hysteroscopies for reproductive failure. Among these, 78 (13.2%) cases of uterine anomalies were found; of these, 64 (82%) were partial uterine septa. Comparing hysteroscopic and hysterographic findings in these women, we found that the value of hysterography in detecting this anomally is limited; 86% of incomplete septa were missed by hysterosalpingogram. In addition, an incomplete septum may have a significant impact on reproductive failure, similar to that of a complete uterine septum.
Laparoscopic Hysterectomy With a Modified CISH Procedure EF Gassibe, E Gassibe. Instituto Proas de Procreacion Astitida y Cirugia Laparoscopica, Mendoza, Argentina.
From March 1992 to February 1995 we performed 62 laparoscopic hysterectomies, 54 of which were the classic intrafascial Semm hysterectomy (CISH). We believe this is the first Argentinian experience with this
S17